Objective To systematically evaluate the efficacy and safety of silybin for the prevention of antituberculosis drug-induced liver injury using a meta-anal. Methods The randomized controlled clin. trials (RCTs) reporting the prophylactic use of silybin in antituberculosis therapy were jointly searched using Me SH in electronic databases including China Journal Full-text Database (CNKI), VIP Database (VIP), Wanfang Data Database (Wanfang Data), Sinomed Database(Sinomed), Pub Med, and the Cochrane Library, and the time limit was set during the period from the start of the database until July 2020. The methodol. quality of the included studies was assessed using the modified Jadad method, and the incidence rates of drug-induced liver injury and adverse reactions were compared between the exptl. and control groups using the relative risk (RR) and 95%confidential interval (CI). The publication bias of the included studies was evaluated using a funnel plot. Results A total of 11 RCTs that met the inclusion and exclusion criteria were included in the final meta-anal., and the 11 studies recruited 1 969 patients, including 989 subjects in the exptl. group and 980 in the control group. There were 7 RCTs with a Jadad score of 1, 2 with a score of 4, 1 with a score of 6, and 1 with a score of 7. Meta-anal. revealed a significantly lower incidence of liver injury in the exptl. group than in the control group[RR=0.35, 95%CI (0.23, 0.52), P<0.000 01], and no significant difference in the incidence of adverse reactions between the exptl. and control groups[RR=1.05, 95%CI (0.70, 1.58), P=0.82]. Sensitivity anal. showed that the meta-anal. results were stable, and the funnel plot was asym., suggesting the possible publication bias. ConclusionSilybin shows a prophylactic activity against antituberculosis drug-induced liver injury without an increase in the incidence of drug-induced adverse reactions.